Having graduated this year and having started as a brand new FY1, Dr Jr (Doctor Junior) has decided it may be a good idea to chronicle what happens, his views of the good old NHS from a fresh faced, bright eyed view as a junior doctor in the NHS.

Monday, 9 August 2010

I'm sure we've all heard a lot about EWTD and impressions from many important people across the media and blogosphere. For those of you who don't know what EWTD is, I'll give a brief synopsis.

The European Working Time Directive was introduced in June 2000, with the aim of reducing working hours across Europe to less than 48 hours a week on average. The reasoning is that work related stress is a major problem, accounting for vast amounts of sick leave, and that excessive hours are one of the main contributing factors to this. Penalties are levied for any organisation that makes its workers work more than an average 48 hours per week. This is of course, an average. If you work 96 hours one week, and then none the next, it all balances out. Other rules include having at least 24 hours off in any 7 days, or 48 in any 14.

Excessive hours have driven this doctor
to telepathic communication with the walls...

The NHS, being the slow, cumbersome monolith that it is, were very slow to introduce the changes. Eventually, the NHS fell into line in 2009, taking a very slow route to get there.

There have, of course, been supporters and detractors in the NHS. One of the big worries is the loss of training that this provides. One of the most vocal critics is the Royal College of Surgeons, who claim that it leaves hospitals "less safe". They have consistently said that it means that Consultants cannot be there throughout the stay of their patients and that training for juniors will be much impacted, leading to a new wave of consultants who will supposedly know very little.

As a jobbing junior doctor, my view on this is slightly different. I am working mainly in medicine at the moment. My career aspiration is not fully set yet, but I'm thinking of anaesthetics. But for now, I'm just a lowly FY1.

In my opinion, 48 hours is a decent amount of hours to work, infact, I have no complaints at all. One of the biggest things that seem to worry my seniors is that I won't get enough "experience". Now in a perfect world, Dr Jr would fully agree with that, however, this is simply not how it works.

For a start, I don't work 48 hours a week. I work much more. I don't leave until at least an hour after I'm supposed to finish, sometimes more. Yes maybe that is partially down to inexperience, however, leaving earlier just leaves me more work for the next day.

To address concerns about experience, in the one week I have worked, I can count how many times I've used my "clinical noggin" on both hands. Most of my work involves filling reams of paperwork. Doing the ward round is the most valuable experience of my day (although running around at light speed trying to translate the volumes of gobbledegook coming out of my Consultant's mouth into a succinct output of events on paper is never fun), everything after that is simple paperwork. Blood forms, drug chart rewriting, examination requests, discharges and the like form the bulk of my working day, which requires little medical knowledge or skill.

Most importantly, I wouldn't deem it as "experience". After the first few forms, you learn very little about medicine. You do as your consultant tells you. "Order this CTPA for this suspected PE", "I need FBCs, U+Es and a CRP for this patient", "Doctor, can you write up this patient for some paracetamol please?"

Working more than 48 hours a week simply means I do more paperwork and the trust employs less doctors. I'm stretched enough as it is (I cover two wards of different specialities by myself. No SHO or reg on the wards).

Managers hate it too. It means they need to employ more staff, which of course costs more money. And everyone knows that if it costs money, managers will find a way around it, even if it means overworked, grumpy staff.

Yes, I can understand that further down the line, experience will come more readily, but for the F1, more hours brings nothing but more paper. For people like myself, EWTD allows a work life balance and at least I can be recovered going into work the day after. Does anyone care what the F1 thinks? I hesitate to comment.

Dr Jr versus Admin: The Running Score

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Content copyright to the author(s). Content not to be used in the commercial media or for profit without prior consent. Names and places changed to protect patient confidentiality. All of the blog is a true account of life on the wards. I think.